Atherosclerosis: research is focusing on HDL cholesterol (Photograph: SPL)

Evacetrapib, one of a new class of treatments called cholesteryl ester transfer protein (CETP) inhibitors, was shown to more than double levels of HDL cholesterol. Higher levels are thought to have a protective effect against CHD.

The challenge to prevent cardiovascular disease has led researchers to focus on HDL cholesterol. People with elevated HDL show reduced incidence of CHD, while those with cardiovascular risk factors such as obesity and diabetes have lower levels.

The researchers noted: ‘However, development of drugs that increase HDL cholesterol levels has been challenging and fraught with failures.’

A team led by Stephen Nicholls of the Cleveland Clinic in Ohio conducted an RCT to test the effects, safety and tolerability of evacetrapib.

They assigned 398 patients to receive either placebo, various dosages of evacetrapib alone or statin therapy with or without the new drug.

After just 12 weeks, patients on evacetrapib alone saw average reductions in LDL cholesterol of up to 40%, or 1.33mmol/L. In addition, those on the highest dose evacetrapib also saw a rise in HDL cholesterol of up to 132%, or 1.71mmol/L.

By contrast, LDL cholesterol rose by 3% and HDL cholesterol fell by 3% among patients on placebo.

Researchers found that LDL cholesterol fell even further among those on evacetrapib 100mg in combination with statin therapy, although there was no further rise in HDL cholesterol.

They concluded: ‘These preliminary findings suggest that evacetrapib could be administered with statins and may yield potentially clinically important incremental effects on lipoproteins.’